PHIN COMMUNITY OF PRACTICE MEMBER INTEREST SURVEY THIS TEMPLATE

little Hultonwalkden Community Committee 26th July 2004 Walkden Congregational
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BEVILL STATE COMMUNITY COLLEGE LIBRARIES ASSIGNMENT ALERT

BEVILL STATE COMMUNITY COLLEGE LIBRARIES LIBRARY SERVICES
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CLALLAM COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT

Tools




PHIN Community of Practice

Member Interest Survey


This template provides you with the PHIN Communities of Practice header. Please feel free to add your community’s logo and customize to suit your needs.


A Member Interest Survey allows the core leaders of a PHIN Community of Practice to determine where member interest lies and what skills members may be able to contribute. This tool can help determine the topics in which community members are interested.


This template provides suggestions for identifying members’ interests, depth of experience in a particular area, and whether they have a particular expertise. The survey can be used to discover members' interests for a defined period of time or in response to a specific event.


When building the survey, consider incorporating the results of the tools your community used to develop a core group or membership base. For example, were there any hot button issues consistently identified with the “Could it be a CoP?” or through the “Interview Approach” resources? When the survey is complete, consider compiling the results in the “Membership Tracking Template,” an Excel tool that allows you to track invitees and members and their skills and interest areas.

[Domain] Community of Practice

Member Interest Survey



Introduction:


Our collective interests and skills shape who we are and what we can do as a community. The [Domain] Community of Practice needs to hear from you in order to direct the aims and activities of the community and to inform and improve its future development. We are very grateful for your time and assistance in completing this questionnaire.


Please provide contact information and indicate your skills and interests by checking the boxes below. Upon completion, please submit the form to [insert contact information or submission instructions].


As needs arise, other community members or leaders may contact you to inquire about your interest or availability in leading or contributing to a particular committee or project. Checking an item does not obligate you in any way—you can make a decision to serve at the time you are asked, when you have more information about the actual work involved.


Have your interests or availability changed? Update your information and resubmit the form to [insert contact information or submission instructions].


About You:


Please provide your contact information (optional):


Name:

   

Agency:

     

Title:

      

E-mail address:

      


Your Role:

Please select the one category that best describes your role:


I am, or intend to be, a leader in the [Domain] Community of Practice.


I am an active member/participant in the [Domain] Community of Practice.


I am an occasional participant in [Domain] Community of Practice events.



Expertise/Skill Areas:


Please select the areas below to which you feel you might be able to contribute time and energy. For each of the areas please choose…


The left box if you have expertise (skill) in the area.

The right box if you are interested in helping in the area, regardless of your expertise.


Don't check the boxes if you have neither interest nor expertise in the area, or if you have interest or expertise you don’t wish to share.


Expertise in the area

Years of experience

I can work in this area

Area

     

[Add Interest Area]

     

[Add Interest Area]

     

[Add Interest Area]

     

[Add Interest Area]

     

[Add Interest Area]

     

[Add Interest Area]

     

[Add Interest Area]

     

[Add Interest Area]

     

[Add Interest Area]

     

[Add Interest Area]


For the areas in which you have interest, please tell us which are your top three priorities.


Priority 1:

    

Priority 2:

    

Priority 3:

    



Additional Information or Comments

     



Thank you for your time.


Please submit the form to [insert contact information or submission instructions].

For [Domain] Community of Practice use.

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Tags: community of, [domain] community, survey, interest, community, practice, member, template